CME INDIA Presentation by – Dr N K Singh, Admin, CME INDIA.

Doctors in Distress

At this time, everywhere, lots of doctors and their families are in grip of COVID distress. Every day, we fear what will happen? Lots of members and their families of CME INDIA group are also in suffering. Public at large are fearless and propagating the infection with ill-designed style of masking which I find never covers nose and, while talking, it is kept below neck.

It is well known that talking can propagate the virus in very efficient way. It is felt that sooner or later, all of us is going to harbour the virus. Herd immunity is on the way, it just a matter of time. This version of epidemiologists is a mirage. It was told that “to end the pandemic, the virus must either be eliminated worldwide — which most scientists agree is near-impossible because of how widespread it has become — or people must build up sufficient immunity through infections or a vaccine. It is estimated that 55–80% of a population must be immune for this to happen, depending on the country” (J Infect2020 Jun;80(6): e32-e33. doi: 10.1016/j.jinf.2020.03.027. Epub 2020).

We are fed up with virtual webinars and want to do CMEs in person.

Time line of epidemiologists to pre-COVID world is highly unpredictable. These modellers agree on two things: COVID-19 is here to stay, and the future depends on a lot of unknown things. It depends on whether people develop lasting immunity to the virus, what happens to seasonality and behaviours of governments and individuals. Fear of annual surges of COVID-19 is probably a reality. Better prediction can be done today not with virus behaviour but on behaviour of individual habits in SMS (Social distancing, Masking and Sanitizers)

Vaccine arrival is expected in next six months and all depends on how long the immune system stays protective after vaccination or recovery from infection. Astrologers said that by the end of September COVID will vanish as planetary changes tune in right direction. But this possibility is also not visible. Enemy is a great chameleon and super strong. 

If nothing becomes feasible then a very painful world is visible.

Let us see these possibilities:

1. If the virus induces short-term immunity — similar to two other human coronaviruses, OC43 and HKU1, for which immunity lasts about 40 weeks — then people can become reinfected and there could be annual outbreaks.
2. Another possibility is that immunity to SARS-CoV-2 is permanent. In that case, even without a vaccine, it is possible that after a world-sweeping outbreak, the virus could burn itself out and disappear by 2021. However, if immunity is moderate, lasting about two years, then it might seem as if the virus has disappeared, but it could surge back as late as 2024. [Source- Center for Infectious Disease Research and Policy. COVID-19: The CIDRAP Viewpoint (CIDRAP, 2020); available at https://go.nature.com/2dfmbqj.]

Bottom-line is, all depends on IMMUNITY. Recently Nature journal has published a very interesting research to understand the male vs female mortality rate and immunological response has been found markedly different. In the online published article title “Do immune responses against SARS-CoV-2 differ between sexes, and whether such differences explain male susceptibility to COVID-19” authors have presented a very interesting finding.

(Takahashi, T. et al. Sex differences in immune responses that underlie COVID-19 disease outcomes. Nature) https://doi.org/10.1038/s41586-020- 2700-3 (2020).

Main findings are:

• To elucidate the immune responses against SARS-CoV-2 infection in men and women, Takahashi, T.et al.  performed detailed analysis on the sex differences in immune phenotype. evaluate the difference in immune response over the disease course between male and female patients.
• They did assessment of viral loads, SARS-CoV-2 specific antibody levels, plasma cytokines/chemokines, and blood cell phenotypes. They analysed on patients with moderate disease who had not received immunomodulatory medications. They also analysed the levels of 71 cytokines and chemokines in the plasma. Levels of many pro-inflammatory cytokines, chemokines and growth factors, including IL-1β, IL-6, IL-8, TNF, CCL2, CXCL10, and G-CSF, are elevated in the plasma of COVID-19 patient
• It was found that in male patients plasma levels of innate immune cytokines such as IL-8 and IL-18 were raised along with more robust induction of non-classical monocytes. In contrast, female patients mounted significantly more robust T cell activation than male patients during SARS-CoV-2 infection, which was sustained in old age.
• Monocyte differences by sex: Findings suggest that progression from classical to non-classical monocytes may be arrested at the intermediate stage in female patients, and that elevated innate inflammatory cytokines and chemokines are associated with more robust activation of innate immune cells at the baseline as well as more robust longitudinal T cell decrease in male patients.
• Higher T cell activation in women: Female COVID-19 patients were found having more abundant activated and terminally differentiated T cell population than male patients at baseline in unadjusted analyses.
• Sex dependent immunity and disease course has been co-related and important sex related potential prognostic/predictive factors for clinical deterioration of COVID-19 is a big possibility
• While poor T cell responses appears to be associated with future progression of disease in male patients, higher innate immune cytokine levels are associated with worsening of COVID-19 disease in female patients.
• This unique research provides a potential basis for taking sex-dependent approaches to prognosis, prevention, care, and therapy for patient with COVID-19.
• Authors conclude that “Collectively, these data suggest that vaccines and therapies to elevate T cell immune response to SARS-CoV-2 might be warranted for male patients, while female patients might benefit from therapies that dampen innate immune activation early during disease. Immune landscape in COVID-19 patients is considerably different between the sexes, and these differences may underlie heightened disease susceptibility in men.” (IMPACT STUDY done at Dept. of Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA)

CME INDIA Tail Piece:

Indian Health Ministry says that mortality analysis of the available data shows that 50% of deaths have happened in the age group of 60 years and above; 37% deaths belong to 45 to 60 years age group; while 11% deaths belong to 26-44 years age group. In the gender-wise distribution, 68% of people who died were men and 32% were women. Does the above research from Nature sufficiently explain the cause of differences?

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